贵阳城区40岁及以上TSH正常水平人群短期心血管事件发病率的队列研究

A cohort study on the incidences of short-term cardiovascular events in residents aged 40 years old and above with normal TSH levels in Guiyang urban area

目的探讨贵阳地区40岁及以上人群中促甲状腺激素(TSH)正常水平与短期心血管事件发病率的关系。方法选取贵阳市云岩区40岁及以上年龄、且血清TSH水平在正常范围内的居民7445人,分为第1组(TSH 0.550~1.499 mU/L,1241人)、第2组(TSH 1.500~2.499 mU/L,2553人)、第3组(TSH 2.500~3.499 mU/L,2118人)及第4组(TSH 3.500~4.780 mU/L,1533人),收集4组居民随访前(基线)的一般情况[性别、年龄、收缩压(SBP)、舒张压(DBP)等],统一仪器测量身高、体质量、腰围并计算体质量指数(BMI);采集空腹静脉血5 mL,2 mL用于检测血糖(FBG),2 mL分离血清后检测高密度脂蛋白(HDL-c)、低密度脂蛋白(LDL-c)、甘油三酯(TG)及总胆固醇(TC),1 mL分离血清后检测血清TSH水平,同时记录4组居民心血管事件(冠心病、心肌梗死、心力衰竭)和脑血管事件(脑出血、脑梗死)发生情况;随访2.97~3.17年,收集4组居民中首次发生心脑血管事件和因首次心脑血管事件而死亡情况,采用Logistic回归分析参考范围内TSH水平对心脑血管事件发病率的影响。结果4组随访居民女性构成、TC、TG及LDL-c水平的差异有统计学意义(P<0.05);4组随访居民标化后心脑血管事件发病率分别为2.13%、2.32%、2.62%及3.01%,差异无统计学意义(P>0.05);Logistic线性回归分析结果表明,TSH水平不是短期心脑血管事件发病率的影响因素(P>0.05)。结论贵阳地区40岁及以上TSH不同参考值水平人群的短期心血管事件发病率相似,未发现降低TSH参考范围上限值对降低心血管事件短期发病率有益的证据。

Objective To investigate the relationship between normal thyroid-stimulating hormone(TSH)levels and the incidence of short-term cardiovascular events in Guiyang residents aged 40 years old and above.Methods A total of 7445 residents(≥40 years old)with normal serum TSH levels were recruited in Yunyan district of Guiyang.Based on serum TSH levels,these residents were divided into the first group(TSH 0.550-1.499 mU/L,n=1241),the second group(TSH 1.500-2.499 mU/L,n=2553),the third group(TSH 2.500-3.499 mU/L,n=2118)and the fourth group 4(TSH 3.500-4.780 mU/L,n=1533).Before follow-up,general information(baseline)including gender,age,systolic blood pressure(SBP),diastolic blood pressure(DBP)were collected.Body height,body weight,and waist circumference were measured using the same model of height/weight instrument.Body mass index(BMI)was calculated.Fasting venous blood(5 mL)was collected,among which,2 mL used for detecting fasting blood glucose(FBG),2 mL for isolating the serum to detect high-density lipoprotein(HDL-c),low-density lipoprotein(LDL-c),triglycerides(TG),and total cholesterol(TC),1 mL for isolating serum to detect TSH levels.Additionally,cardiovascular events(coronary heart disease,myocardial infarction,heart failure)and cerebrovascular events(cerebral hemorrhage,cerebral infarction)were recorded at the same time.During follow-up visits lasting 2.97 to 3.17 years,the first cardiovascular/cerebrovascular events,and deaths due to the first cardiovascular/cerebrovascular events were collected.Logistic regression was applied to analyze the impact of TSH levels within the reference range on the incidences of cardiovascular/cerebrovascular events.Results The differences in female composition,TC,TG,and LDL-c levels among the four groups were statistically significant(P<0.05).The incidences of cardiovascular and cerebrovascular events after standardization in four groups were 2.13%,2.32%,2.62%,and 3.01%,respectively(P>0.05).Logistic linear regression analysis revealed that TSH level is not a factor influencing the incidences of short-term cardiovascular and cerebrovascular events(P>0.05).Conclusion The incidence of short-term cardiovascular events in people with different TSH levels within the reference range of 40 years and over in Guiyang is similar.There is no evidence that reducing the upper limit of the reference range of TSH is beneficial to reduce the short-term incidence of cardiovascularevents.